Correlates of Same-sex Behavior Disclosure to Health Care Providers Among Black MSM in the United States: Implications for HIV Prevention

Disclosure of same-sex behavior to health care providers (HCPs) by men who have sex with men (MSM) has been argued to be an important aspect of HIV prevention. However, Black MSM are less likely to disclose compared to white MSM. This analysis of data collected in the United States from 2006–2009 identified individual and social network characteristics of Black MSM (n = 226) that are associated with disclosure that may be leveraged to increase disclosure. Over two-thirds (68.1%) of the sample had ever disclosed to HCPs. Part-time employment (AOR = 0.32, 95% CI = 0.11–0.95), bisexual identity (AOR = 0.29, 95% CI = 0.12–0.70), and meeting criteria for alcohol use disorders (AOR = 0.32, 95% CI = 0.14–0.75) were negatively associated with disclosure. Disclosers were more likely to self-report being HIV-positive (AOR = 4.47, 95% CI = 1.54–12.98), having more frequent network socialization (AOR = 2.15, 95% CI = 1.24–3.73), and having a social network where all members knew the participant had sex with men (AOR = 4.94, 95% CI = 2.06–11.86). These associations were not moderated by self-reported HIV status. Future interventions to help MSM identify social network members to safely disclose their same-sex behavior may also help disclosure of same-sex behavior to HCPs among Black MSM

African American men living with HIV/AIDS in Detroit, Michigan: The impact of age, secrecy, health, and support resources on psychological distress.

In the coming millieum, African American men are expected to constitute the largest segment of society living with HIV/AIDS. There is little research on this population, their use of support resources and the effect of support resources on mental health outcomes. To address this gap, 120 African American men living with HIV/AIDS in Detroit, Michigan were located using convenience and snowball sampling. The main hypotheses were that (1) health (number of symptoms), secrecy about HIV status, and age affect psychological distress (depression); (2) support resources (number of family members who know HIV status, number of friends who know HIV status, number of social services used/received, attendance of social/political groups, participation in organized and/or non-organized religious activities impact psychological distress and the relationship between health, secrecy, and psychological distress. Multivariate analysis (with controls for social class and employment) were run, where support resources were regressed on secrecy, health, and age. The analysis showed that secrecy of HIV status was significantly and negatively associated with number of friends who knew HIV status; health was significant and related to social services received/used, and; age was significant and positively related to number of social services received/used and participation in organized religious activities. Multivariate regressions on psychological distress showed that belonging to the upper/middle class, number of friends who know HIV status, number of family members who know HIV, and number of social services used/received each had a significant and inverse relationship with psychological distress. Age and secrecy were not significant. Health was significantly and positively related to psychological distress. It also had the strongest effect on psychological distress. Using Wheaton's methodology (1985) for identifying mediator variables, it was determined that the number of social services used/received was a suppressor variable for the relationship between number of symptoms and psychological distress. Health, secrecy, and age influence the type of support resources used by African American men living with HIV/AIDS. For this study, having close family members and friends who know HIV status and use of social services were important and significant for decreasing psychological distress.Ph.D.Clinical psychologyHealth and Environmental SciencesMental healthPsychologyPublic healthPublic policySocial SciencesSocial workUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/132251/2/9959866.pd

HIV Testing Among Sexually Active Hispanic/Latino MSM in Miami-Dade County and New York City: Opportunities for Increasing Acceptance and Frequency of Testing

HIV testing behavior is important in understanding the high rates of undiagnosed infection among Hispanic/ Latino men who have sex with men (MSM). Correlates of repeat/recent testing (within the past year and ≥5 tests during lifetime) and test avoidance (never or \u3e5 years earlier) were examined among 608 sexually active Hispanic/Latino MSM (Miami-Dade County and New York City). Those who reported repeat/recent testing were more likely to have incomes over $30,000, speak English predominately, and have visited and disclosed same-sex behavior to a health care provider (HCP) in the past year. Those who were classified as test avoiders were less likely to have incomes over$10,000 and to have seen an HCP in the past year. The main reason for not testing (in both groups) was fear of HIV positivity; however, twice as many test avoiders considered this their main reason, and more test avoiders had confidentiality concerns. Results suggest that messages to encourage testing among Hispanic/ Latino MSM may be most effective if past testing patterns and reasons for not testing are considered. HCPs can play an important role by consistently offering HIV tests to MSM and tailoring messages based on prior testing histories

Unhealthy environments, unhealthy consequences: Experienced homonegativity and HIV infection risk among young men who have sex with men

Unfavourable social environments can negatively affect the health of gay, bisexual, and other men who have sex with men (MSM). We described how experienced homonegativity – negative perceptions and treatment that MSM encounter due to their sexual orientations – can increase HIV vulnerability among young MSM. Participants (n = 44) were young MSM diagnosed with HIV infection during January 2006–June 2009. All participants completed questionnaires that assessed experienced homonegativity and related factors (e.g. internalised homonegativity). We focus this analysis on qualitative interviews in which a subset of participants (n = 28) described factors that they perceived to have placed them at risk for HIV infection. Inductive content analysis identified themes within qualitative interviews, and we determined the prevalence of homonegativity and related factors using questionnaires. In qualitative interviews, participants reported that young MSM commonly experienced homonegativity. They described how homonegativity generated internalised homonegativity, HIV stigma, silence around homosexuality, and forced housing displacement. These factors could promote HIV risk. Homonegative experiences were more common among young Black (vs. non-Black) MSM who completed questionnaires. Results illustrate multiple pathways through which experienced homonegativity may increase HIV vulnerability among young MSM. Interventions that target homonegativity might help to reduce the burden of HIV within this population

Sociodemographic and risk behavior characteristics associated with unprotected sex with women among black men who have sex with men and women in New York City

The objectives of this cross-sectional study were to compare sociodemographic and risk behavior characteristics between black men who have sex with both men and women (MSMW) and those who have sex with men only (MSMO) and assess factors associated with having any unprotected vaginal and/or anal intercourse (UVAI) with women in the last 3 months. Data from 326 black men who reported recent unprotected anal intercourse with a man in an HIV behavioral intervention study in New York City were analyzed. Baseline characteristics were compared between MSMW and MSMO, and factors associated with having any UVAI in the past 3 months with women among MSMW were evaluated. In total, 26.8% reported having sex with both men and women in the last 3 months. MSMW were less likely to be HIV infected, use amyl nitrates, and have unprotected receptive anal sex with most recent male partner. MSMW were more likely to be over 40 years old and use heroin. A total of 55.6% of MSMW reported having UVAI with women in the last 3 months. Compared to MSMW having only protected sex, MSMW having any UVAI with women were less likely to be HIV infected and to disclose having sex with men to female partners; they were more likely to have greater than four male sex partners in the last 3 months. In conclusion, HIV prevention interventions among black MSMW should directly address the risk of HIV transmission to both their female and male partners. Disclosure of bisexuality to female partners may be an important component of future prevention efforts. © 2012 Taylor & Francis